Background Recent studies have shown a significant improvement in overall survival with the addition of adjuvant chemotherapy after surgical resection of lung cancer. The ANITA study was designed to evaluate the survival impact of adjuvant NP compared to observation alone in patients with completely resected lung cancer. This study has been presented previously and these are considered the final results of this study

There is no benefit with the addition of NP in patients with stage Ib NSCLC

Toxicity of NP was manageable

Future studies should investigate the role of radiation in addition to chemotherapy in patients with N2 disease

Clinical/Scientific Implications

This study adds to the growing body of scientific literature that supports the use of chemotherapy in patients that have undergone a complete resection of their NSCLC. This study also questions the use of chemotherapy in patients with Ib (T2N0) NSCLC as no benefit is seen in survival, which is consistent with the recent JBR-10 study recently published in the New England Journal of Medicine. As has been seen in other disease sites, as the systemic control of disease improves, local therapy with radiation gains importance. Radiation has previously been criticized as detrimental in the postoperative setting because there was toxicity and no survival benefit. As has been confirmed in numerous studies, this study shows there is no benefit to postoperative XRT in patients with N0 or N1 disease that has been completely resected. However, this study does show a potential benefit in patients with N2 disease. Previous studies have shown improved local control with the addition of XRT, but no survival advantage. However, as has been show previously with breast cancer, until there is a significant systemic impact with chemotherapy, there is not a large impact of radiation. Based on the results of this subgroup analysis, the authors have suggested future trials investigate the role of radiation in patients with N2 disease.